Transcatheter Aortic Valve Replacement: Outcomes of Patients With Moderate or Severe Mitral Regurgitation

Study Questions:

What is the impact of mitral regurgitation (MR) on outcomes after transcatheter aortic valve replacement (TAVR) and the impact of TAVR on MR?

Methods:

The outcomes of patients with mild or less (n = 319), moderate (n = 89), and severe (n = 43) MR were evaluated after TAVR at two Canadian centers.

Results:

Patients with moderate or severe MR had a higher mortality rate than those with mild or less MR during the 30 days after TAVR (adjusted hazard ratio, 2.10; 95% confidence interval, 1.12-3.94; p = 0.02). However, the mortality rates after 30 days were similar (adjusted hazard ratio, 0.82; 95% confidence interval, 0.50-1.34; p = 0.42). One year after TAVR, moderate MR had improved in 58%, remained moderate in 17%, and worsened to severe in 1%, and 24% of patients had died. Severe MR had improved in 49% and remained severe in 16%, and 35% of patients had died. Multivariate predictors of improved MR at 1 year (vs. unchanged MR, worse MR, or death) were a mean transaortic gradient ≥40 mm Hg, functional (as opposed to structural) MR, the absence of pulmonary hypertension, and the absence of atrial fibrillation.

Conclusions:

The authors concluded that moderate or severe MR in patients undergoing TAVR is associated with a higher early, but not late, mortality rate.

Perspective:

This study suggests that moderate or severe MR in patients undergoing TAVR is associated with a higher mortality rate during the first 30 days, but not thereafter. Furthermore, at 1-year follow-up, MR was improved in 55% of patients with moderate or severe MR at baseline. Such improvement was more likely in patients with high transaortic gradients, with functional MR, without pulmonary hypertension, and without atrial fibrillation. These findings demonstrate late functional benefit in survivors and are consistent with, but do not prove, a possible late survival benefit. Overall, TAVR appears to be a reasonable strategy in patients with combined aortic and mitral valve disease if carefully selected by a multidisciplinary team.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, Valvular Heart Disease, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Pulmonary Hypertension, Interventions and Structural Heart Disease, Mitral Regurgitation

Keywords: Survivors, Incidence, Follow-Up Studies, Mitral Valve Insufficiency, Hypertension, Pulmonary, Canada, Heart Valve Diseases, Cardiovascular Diseases, Risk Factors, Heart Valve Prosthesis Implantation, Transcatheter Aortic Valve Replacement


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